一次性微创胸腔穿刺包的动物实验研究

目的通过动物实验评价一次性微创胸腔穿刺包对胸腔积液进行穿刺引流的治疗效果。方法选用健康实验用猪16只,建立胸腔积液模型,随机分为两组,实验组（n=8）：采用一次性微创胸腔穿刺包进行胸腔穿刺引流;对照组（n=8）：采用普通胸腔穿刺包进行胸腔穿刺引流。对两组实验动物的胸腔穿刺引流量进行比较分析。结果对照组胸腔穿刺引流过程中出现1例气胸,实验组无一例并发症发生;实验组的胸腔穿刺引流量明显高于对照组（P〈0．05）。结论采用一次性微创胸腔穿刺包进行胸腔穿刺引流是安全有效的。     

新型一次性胸腔抽液针的制作与临床应用研究

目的 探讨自制的新型一次性胸腔抽液针的临床应用效果.方法 根据Y形静脉留置针的制作材料和形状,设计制作成带有刻度和侧孔的新型一次性胸腔抽液针并应用于临床.选择68例胸腔积液的病人,随机分为观察组和对照组.对照组采用传统的胸腔穿刺针进行穿刺抽液,观察组采用新型的一次性胸腔抽液针进行穿刺抽液.观察两种穿刺针在疼痛程度、患者满意度、医生满意度及并发症发生率等方面有无差异性.结果 两种穿刺针在疼痛程度、患者满意度、医生满意度方面差异有统计学意义(P＜0.01).并发症发生率比较发现,观察组抽吸顺利无反应,无医源性损伤和胸膜反应出现;34例患者留置套管5～8 d,无1例感染发生.对照组有3例发生胸膜反应.结论 新型一次性胸腔抽液针可以在治疗期间内保留在患者的身体上,减少了因反复多次抽液带来的痛苦,安全可靠,医务人员操作方便;易掌握穿刺深浅,可避免意外损伤的发生,并且制作简单、价格低廉,适合基层医院推广应用.     

新型胸腔穿刺装置的临床应用和护理

传统的胸腔穿刺针在临床使用中有不足之处,我们将穿刺装置进行改进,研制一种新型的一次性胸腔穿刺装置,此装置获得了国家实用新型专利,专利号：ZL2005200821461。经临床应用,效果满意。现将其临床应用和护理体会报告如下。     

新型硅胶管在胸腔穿刺包中的应用

胸腔穿刺包是肺科、胸外科常用的诊疗包。常规的穿刺包中16号或18号胸腔穿刺针,针栓需连接一根直径为0.6cm、长15cm的橡皮管,但经2次高温高压灭菌后,往往容易产生老化,发粘,影响临床使用质量。我供应室1996年底开始改用新型硅胶管,取得较好的效果,临床使用满意率100％。现介绍如下。     

一次性膀胱穿刺包的研制

目的研制一次性膀胱穿刺包。方法采用一次性医用材料制作一次性膀胱穿刺包,环氧乙烷消毒,并对105例需导尿的患者进行临床验证。结果利用一次性膀胱穿刺包进行导尿的成功率、感染率与常规导尿组相比有显著差异(P<0.01)。结论一次性膀胱穿刺包导尿成功率高、尿道感染率低,患者易接受。     

应用一次性留置针及负压引流器行胸腔积液引流的方法

胸腔穿刺术是人们所熟悉的一项临床治疗胸腔积液的技术。以往使用一次性胸腔穿刺抽液器。虽然避免了各项繁琐的衔接工作，但患不能深呼吸、咳嗽等。抽吸胸腔内积液时，术必须固定好穿刺针，以免发生气胸。近几年我科应用一次性留置针及负压引流器对肺癌并胸腔积液患进行了胸腔穿刺引流并注入化疗药物治疗胸腔积液，由于方法的改进，使患在胸穿时轻松自如，且减少了术反复抽取胸腔内积液的复杂操作，并避免了气胸的发生，效果满意。现将方法介绍如下。     

一次性麻醉穿刺包与普通腹腔穿刺包在腹腔化疗中的应用比较

目的探讨一次性麻醉穿刺包与普通腹腔穿刺包在腹腔化疗中应用效果。方法将2008年6月-2009年4月住院的胃癌和卵巢癌行腹腔化疗的患者53例,随机分为两组。实验组29例,用一次性麻醉穿刺包行腹腔穿刺化疗;对照组24例,用普通腹腔穿刺包行腹腔穿刺化疗;比较两组患者应用不同穿刺包行腹腔穿刺化疗的并发症比较。结果实验组并发症发生率明显低于对照组（P〈0.05）。结论一次性麻醉穿刺包应用于腹腔化疗中操作简便、创伤小、并发症少,患者乐于接受等优点,值得在临床上推广使用。     

电视胸腔镜联合小切口在自发性气胸治疗中的应用

自发性气胸以往采用胸腔穿刺抽气、胸腔闭式引流、胸腔内注射粘连剂等保守治疗,住院时间长,且疗效不确切、复发率高[1].随着微创技术的发展,电视胸腔镜技术(VATS)作为新近崛起的微创手术方式,已用于自发性气胸的治疗,但内镜切开缝合器(Endo-G1A)和钛夹等一次性器械费用高.本科采用电视胸腔镜联合小切口手术(VAMT)治疗自发性气胸,效果满意,费用亦较低.     

1例微创胸腔闭式引流造血干细胞移植病人的观察及护理

[目的]了解微创持续负压胸腔闭式引流护理对有胸腔积液造血干细胞移植病人的治疗影响。[方法]用美国Arrow公司生产的中心静脉导管,采取深静脉穿刺法在所定的穿刺点将导管置入胸腔,进行持续负压胸腔闭式引流,术后加强临床观察和护理,保持引流通畅。[结果]病人胸腔积液完全吸收,造血干细胞移植成功。[结论]通过加强微创胸腔闭式引流造血干细胞移植病人的临床观察和护理,能够保证造血干细胞移植的顺利进行。     

1例微创胸腔闭式引流造血干细胞移植病人的观察及护理

[目的]了解微创持续负压胸腔闭式引流护理对有胸腔积液造血干细胞移植病人的治疗影响。[方法]用美国Arrow公司生产的中心静脉导管,采取深静脉穿刺法在所定的穿刺点将导管置入胸腔,进行持续负压胸腔闭式引流,术后加强临床观察和护理,保持引流通畅。[结果]病人胸腔积液完全吸收,造血干细胞移植成功。[结论]通过加强微创胸腔闭式引流造血干细胞移植病人的临床观察和护理,能够保证造血干细胞移植的顺利进行。     

微创刨吸术治疗下肢静脉曲张患者的护理

报道微创刨吸术治疗下肢静脉曲张的护理。微创刨吸术是治疗下肢静脉曲张的一种有效新技术,具有术后恢复快、美观等优点。总结73例行该技术治疗患者的护理经验:术前适当的护理宣教与心理辅导,能增加患者对此新技术的信心,术后加强病情观察,指导术后活动和穿弹力袜,注意预防并发症,促进患者身心康复。     

Ultrasound findings following failed,clinically directed thoracenteses

We prospectively examined 26 patients who were referred for ultrasoundguided thoracentesis, following at least one unsuccessful, clinically guided attempt. Sonographically guided thoracentesis was successful in obtaining fluid in 88% of patients. In addition, ultrasonography proved useful in suggesting or defining the cause for the initial unsuccessful attempt. Patients who have undergone an unsuccessful clinically guided thoracentesis and are referred for sonographic assistance represent a selected group who may have complicating factors not typically present during routine thoracentesis. Awareness of these potential complicating factors may facilitate the performance of ultrasound-guided thoracenteses. © 1994 John Wiley & Sons, Inc.     

The other randomization — methods for labeling drug kits

PurposeMost phases 2 and 3 blinded randomized clinical trials package study drug, e.g., active and placebo, into drug kits for distribution to investigational sites. Kits are made so that it is not possible to determine the type of drug in the kit. This enables investigators to administer drug to patients in a manner that blinds investigators and patients. Kits are labeled with unique kit IDs that code for the drug type. Kit lists contain the assignment of kit IDs to drug. Algorithms for making kit lists, like algorithms for randomizing patients, incorporate randomness to ensure investigators and patients are blind to the process. This paper reviews three types of kit list: blocked, double randomized, and scrambled, and discusses the operational benefits of what a pharmaceutical company might obtain using scrambled lists along with an overview of the challenges of generating and extending the lists for large trials.MethodsWe reviewed the operational characteristics of three types of kit list: blocked, double randomized, and scrambled.ResultsBlocked kit lists were a popular choice until their unblinding and operational deficiencies became well known. The many difficulties associated with blocked kit lists are unnecessary and can be avoided by using a double randomized kit list or a scrambled kit list. Compared to double randomized kit lists, scrambled kit lists can be more easily extended due to their advantage of having randomly sized gaps between kit IDs.ConclusionsAmong the three types of kit list, scrambled kit lists offer the most flexibility. The adoption of scrambled kit lists has in practice provided the many operational benefits described in this paper.     

静脉留置针在临床中的新用途

静脉留置针除用于静脉输液外,还可用于胸腔穿刺、腹腔穿刺及臂丛神经阻滞麻醉。     

静脉留置针在临床中的新用途

静脉留置针除用于静脉输液外，还可用于胸腔穿刺、腹腔穿刺及臂丛神经阻滞麻醉。     

某国产HIV-1核酸定量检测试剂盒的应用性能评估

目的：对某国产人类免疫缺陷病毒Ⅰ型（HIV-1）核酸定量检测试剂盒（PCR-荧光探针法）的临床应用性能进行评估。方法收集不同H IV感染状态人群的血液样品共计247例,分别使用 H IV-1被评估试剂与已被SFDA批准的对照试剂进行临床检验平行对比。比较两种方法之间的相关性和一致性。对比不符样本用国际公认的Roche公司生产的 HIV-1病毒载量检测试剂进行复核。结果共检测247例样本,被评估试剂与对照试剂检测结果一致的样本有233例,检测结果不一致的样本有14例（其中8例阴阳性结果不一致、6例定量结果对数值差异大于1）,14例不符样本用复核试剂检测确认后,均与被评估试剂检测结果一致。以复核试剂检测结果最终判断：被评估试剂的一致率为100．00％。对177例被评估试剂与对照试剂定量线性范围内样本进行统计分析,定量相关性为0．9671。结论被评估试剂与已上市的国内同类产品在检测功能上具有等效性,被评估试剂灵敏度、定量准确性与Roche检测结果一致性相近,高于对照试剂。     

The Safety of Ultrasound-Guided Thoracentesis in Patients on Novel Oral Anticoagulants and Clopidogrel: A Single-Center Experience

ObjectiveTo assess the risk of hemorrhagic complications in patients taking novel oral anticoagulants (NOACs) and/or clopidogrel who underwent an ultrasound-guided thoracentesis.Patients and MethodsA retrospective analysis was performed of ultrasound-guided thoracenteses completed at an academic institution between January 1, 2016, and November 14, 2017. All patients who underwent a thoracentesis while actively receiving treatment with an NOAC and/or clopidogrel were included in the study. Primary endpoints are any significant post-procedure bleeding complication; defined as a hemoglobin decrease of greater than 2 g/dL in 48 hours, hemothorax, chest wall hematoma, and bleeding requiring transfusion, surgery, or chest tube placement.ResultsA total of 115 thoracenteses were performed in 103 patients actively taking an NOAC (n=43) and/or clopidogrel (n=69). All patients used either the NOAC or clopidogrel within 24 hours before the procedure and continued using it daily thereafter. There were no bleeding complications.ConclusionThe overall risk of significant hemorrhage in patients taking an NOAC and/or clopidogrel while undergoing ultrasound-guided thoracentesis is very low. Albeit the total number of procedures reviewed may be insufficient to prove definitive safety, it is sufficient to provide a measure of relative risk when assessing benefits of thoracentesis in these patients.     

Hand-carried ultrasound-guided pericardiocentesis and thoracentesis.

To date, ultrasound-guided centeses have required the use of large, diagnostic ultrasound equipment that can be cumbersome and not readily available. In this study, we sought to evaluate the use of portable, hand-carried ultrasound devices in guidance of pericardiocentesis and thoracentesis. Hand-carried ultrasound was used to define location of the maximal extent of the effusion and its proximity to the skin surface, confirm needle entry and site, and to evaluate postprocedural result. A total of 12 patients who were stable and hospitalized were prospectively enrolled, 9 for pericardiocentesis and 3 for thoracentesis. We concluded that under the direction of a suitably trained physician, hand-carried ultrasound provided images suitable for guidance of a pericardiocentesis or thoracentesis preprocedurally, intraprocedurally, and postprocedurally.     

基底节脑出血微创手术和传统开颅术的疗效比较及影响因素分析

目的比较基底节脑出血微创（小骨窗）开颅手术与传统（骨瓣）开颅手术治疗的疗效，并分析造成差异的因素。方法符合出血性脑卒中规范化治疗人选标准的基底节脑出血患者55例，其中微创手术28例（微创组），传统手术27例（骨瓣组）。观察术后并发症，术后3d及2周意识情况，以及术后3个月的日常生活能力（ADL）。以SPSS10．0进行统计分析。结果术后3d意识障碍者骨瓣组19例，微创组10例（P〈0．01）。骨瓣组出现肺部感染和（或）器官功能障碍17例，而微创组为11例（P〈0．05）。术后3个月骨瓣组植物状态5例，死亡3例，占29．6％；微创组分别为3例和2例，占17．8％（P〈0．05）。除去植物状态及死亡病例，两组ADL比较差异无显著性（P〉0．05）。结论微创手术可使患者意识较早恢复，减少并发症，从而减少植物生存和死亡率，对晚期神经功能恢复无明显影响。